As with everything else, development varies from child to child. In general, the first baby teeth are the lower front (anterior) teeth, and they begin to appear between the ages of six and eight months, although they begin to form before birth. All 20 primary teeth are usually in place by age 3.
Permanent teeth begin appearing around age 6, starting with the first molars (back teeth) and lower central incisors (front teeth). The process continues until about age 21, for a total of between 28 and 32, including the third molars (“wisdom” teeth).
Frequent and long exposure of an infant’s teeth to liquids containing sugar can cause “baby bottle” tooth decay. Milk (including breast milk), formula, fruit juice, and other sweetened drinks can all contribute. Putting a baby down for a nap or for the night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquid pools around the baby’s teeth, promoting acids that attack tooth enamel. If you have already begun giving sweetened beverages and the child won’t fall asleep without them, begin diluting the bottle’s contents with water over two or three weeks.
After each feeding, wipe baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. It helps to sit down and place the child’s head in your lap or lay the baby on a dressing table or the floor, so you can see into the child’s mouth easily.
Sucking is a natural reflex that comforts and relaxes babies and toddlers. Typically, children stop the activity between the ages of 2 and 4, or when permanent front teeth are ready to erupt. After the eruption of the primary teeth, thumb sucking can cause improper growth of the mouth and misalignment of the teeth. If prolonged or vigorous thumb sucking is a problem, discuss this with Dr. Martinez.
To help your child outgrow thumb sucking:
- Don’t scold the child when they suck their thumb, instead praise them when they don’t
- Substitute another comfort device to help children cope with stress or discomfort
- At night, place a bandage on the thumb or a sock on the hand
New teeth are different from established ones, and a gentle toothpaste is important. Adult toothpastes often contain harsh abrasives which wear away young enamel. Make sure your child’s toothpaste is recommended by the American Dental Association for that age group.
Fluorosis is a chalky white to even brown discoloration of the permanent teeth caused by too much fluoride.
- Fluoridated toothpaste at too early an age is the most common cause. Children should spit out, not swallow, toothpaste after brushing to avoid ingesting too much fluoride. If your child is too young to spit and rinse, look for a fluoride-free toothpaste, or use only a pea-sized amount.
- Excessive and inappropriate use of fluoride supplements, without the recommendation of your pediatrician or pediatric dentist. Fluoride tablets, drops, or fluoride-fortified vitamins should not be given to infants younger than six months, and after that only after all other sources of ingested fluoride have been accounted for.
- Certain foods and beverages contain high levels of fluoride, including powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, infant chicken products, decaffeinated teas, white grape juice, and juice drinks manufactured in fluoridated locales. Soft drinks from fast food and convenience stores that blend syrup with carbonated city water that is fluoridated are another source.
Fluoride is an important element that has been proven beneficial to developing and adult teeth. In growing children fluoride strengthens the teeth to help them resist decay. In adults, it reduces sensitivity and remineralizes the enamel.
The most critical time to avoid excess fluoride is from 22 to 26 months, with a continued risk up to 36 months. Fluoride is no longer a concern after age 7.
Digital X-rays, which Dr. Martinez uses, require shorter exposure times for accurate images, which means they use less radiation than previous types so the risks are extremely small. The benefits of being able to detect problems not seen above the gum line with the naked eye are great.
The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay. On average, most pediatric dentists request radiographs approximately once a year. Approximately every 3 years it is a good idea to obtain a complete set of radiographs, which would include a panoramic film.
Bruxism, or nighttime teeth grinding, is a concern because it can damage teeth and jaw. On the other hand, it is usually outgrown before such damage occurs. Among the possible causes are stress, such as a move to a new area, divorce, or problems at school. Another theory is that pressure in the inner ear is being relieved by clenching and unclenching the jaw. Parents might notice the noise caused by grinding while the child is asleep, or in more extreme cases, wear on the teeth.
If wear is excessive, a mouth guard for use at night might be indicated although there is a risk of choking if the device becomes dislodged or improper growth of the jaw.
Most grinding lessens between the ages of 6 and 9, and disappears by age 12. If you notice signs of bruxism, please discuss it with Dr. Martinez.
Participation in sports and recreational activities is good for children, but can cause mouth and tooth injuries. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child’s smile by preventing broken teeth and injuries to the lips, tongue, face, and jaw. When properly fitted and worn, the guard stays in place and it’s easy for the child to talk and breathe. A mouth protector should be used during any activity that could result in a blow to the face. Dr. Martinez can recommend both custom and store-bought mouth guards.